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March 1995

Acneiform Papules on the Neck

Author Affiliations

The Cleveland (Ohio) Clinic Foundation

Arch Dermatol. 1995;131(3):341-342. doi:10.1001/archderm.1995.01690150105021

REPORT OF A CASE  In 1975, a 29-year-old white woman was diagnosed with Wilson's disease by neurologic examination and the presence of Kayser-Fleischer rings. She was given penicillamine (0.5 mg twice daily), which reversed most of her symptoms, and the Kayser-Fleischer rings disappeared. Approximately 14 years later, an acneiform eruption developed on her neck that persisted for 1 year.Physical examination revealed erythematous papules in an arciform pattern on the anterior neck (Figure 1). A lesional skin specimen was obtained and submitted for histopathologic examination (Figures 2 through 4). These lesions failed to respond to intralesional triamcinolone acetonide but later improved with liquid nitrogen cryotherapy.What is your diagnosis?

DIAGNOSIS:  Elastosis perforans serpiginosa (EPS).

HISTOPATHOLOGIC FINDING  Individual papules consisted of a reactive thickened epidermis, increased dermal elastin, and inflammation. The epidermis was hyperkeratotic and acanthotic. Occasionally, the epidermis was disrupted by transepidermal